respiratory infections

1. PRESENTED BY:-
AAKANKSHA SUMEDHA
ROLL. 14

2. INVESTIGATIONS IN PNEUMONIA
BLOOD:
 TLC : very high(>20 x 109/L) or low(<4 x 109/L).
Neutrophilic leucocytosis suggests bacterial aetiology.
 Urea and electrolyte : Urea > 7 mmol/L and
hyponatraemia are markers of severity.
 LFT : abnormal if basal pneumonia inflames liver.
Hypoalbuminaemia is seen in severe cases.
 ESR is raised.
 Blood culture shows bacteraemia
 Cold agglutinin is positive in 50% of patients with
Mycoplasma.

3. SPUTUM:
 Sputum samples : Gram stain, culture and antimicrobial
sensitivity testing.
 Oropharynx swab : PCR for Mycoplasma pneumoniae and
other atypical pathogens.
URINE:
 Pneumococcal and/or Legionella antigen
CHEST X-RAY
PLEURAL FLUID: Always aspirated and sent for culture if
present in more than trivial amount, preferably with ultrasound
guidance.
Blood agar culture of sputum sample

4. Chest x-ray showing right middle lobe
is affected in a patient suffering from
pneumonia.
Gram staining of the sputum
showing causative bacteria.

5. MANAGEMENT OF CAP
OXYGEN :
 It should be administered to all patients with tachypnoea,
hypoxaemia, hypotension or acidosis with the aim of
maintaining oxygen saturation at or above 92%.
 Continuous positive airway pressure should be considered in
those who remain hypoxic despite this.
IV FLUIDS :
 should be considered in pts with severe illness, older pts and
those who are vomiting.
 Ionotropic support may be required in pts with shock.

6.  ANTIBIOTICS :
Uncomplicated CAP Amoxicillin 500mg tid orally
Allergic to penicillin Clarithromycin 500mg bd orally or
Erythromycin 500mg qid orally
Staphylococcus •Flucloxacillin 1-2g qid iv +
• Clarithromycin 500mg bd iv
Mycoplasma or
Legionella
• Clarithromycin 500mg bd oral or iv /
Erythromycin 500mg qid oral plus
•Rifampicin 600mg bd iv in severe cases
Severe CAP • Clarithromycin 500mg bd iv or
Erythromycin 500mg qid iv plus
• Co- amoxiclav 1.2g tid iv or ceftriaxone 1-
2g daily iv or cefuroxime 1.5g tid iv

7. DIAGNOSIS OFHOSPITALACQUIRED
PNEUMONIA
 It should be considered in any hospitalised or ventilated pt
who develops purulent sputum, new radiological
infiltrates, an otherwise unexplained increase in oxygen
requirerment, a core body temperature of more than 38ºC
and a leucocytosis or leucopenia.
 Microbiological confirmation should be sought whenever
possible.
 Investigations same as that of CAP

8. TREATMENT OFHAP
 It is similar to those for CAP, focusing on adequate
oxygenation, appropriate fluid balance and antibiotics.
 In early onset HAP, pt can be treated with co- amoxiclav
or cefuroxime.
 If pt has received a course of antibiotic, then tazobactam
or a third generation cephalosporin should be considered.
 Anti pseudomonal cover may be provided by a
carbapenem or a third generation cephalosporin combined
with aminoglycoside.

9. DIAGNOSIS OFPNEUMONIAINA
IMMUNOCOMPROMISED PATIENT
 The approach depends on the clinical context and severity
of the illness.
 Invasive investigations such as bronchoscopy, BAL,
transbronchial biopsy are often not done.
 Induced sputum offers a relatively safe method of
obtaining microbiological samples.
 Other investigations are similar to that of CAP

10. MANAGEMENT:
 Ideally treatment should be based on the identified
causative organism.
 Commonly a broad spectrum antibiotic therapy is used
such as a third generation cephalosporin or a quinolone,
plus an antistaphylococcal antibiotic or an
antipseudomonal penicillin plus an aminoglycoside.
 Additional antifungal or antiviral therapy may be used.